2026-05-14T08:05:09Z https://bsms.arphahub.com/oai.php

10.3897/bsms.3.120969 2024-06-17 bsms

Artificial intelligence in Laboratory medicine – let’s talk about it Ivanova,Irena Ivanova,Nora Atanasova,Bisera artificial intelligence digitalization laboratory medicine Bulgarian Society of Medical Sciences Journal 3: e120969 Medicine is a science, an art, and a trust between the doctor and the patient. In the times of digitization and artificial intelligence, new relationships between the human being and the machines are establishing. The concept for using computers to stimulate intelligent behavior and critical thinking is firstly described by Alan Turing in 1950. Nowadays, it is time to talk about digital transformation in medicine. AI consists of Machine learning (ML), Deep learning (DL) and Computer vision (CV). New terms appear in medical terminology in the context of digital health and digital transformation, as a new reality, extended reality literally. The purpose of this article is to present some fundamentals of AI and its application in Laboratory medicine in accordance with clinical needs and ethical standards. The way of digitization in human life and in medicine is clear and the process has been started, but there are still many things to be introduced in the same practice. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2024 Letter To The Editor text/html info:doi:10.3897/bsms.3.120969 https://doi.org/10.3897/bsms.3.120969 https://bsms.arphahub.com/article/120969/ https://bsms.arphahub.com/article/120969/download/pdf/ en

10.3897/bsms.4.121275 2024-08-05 bsms

Extrapulmonary forms of tuberculosis. Clinical case report of a child with tuberculous osteoarthritis Pavlov,Petar Stefanov,Stefan Pukalski,Yavor Vasilev,Teodor tuberculosis osteoarthritis pediatric disease pediatric surgery Bulgarian Society of Medical Sciences Journal 4: e121275 Introduction: Tuberculous osteoarthritis, caused by Mycobacterium tuberculosis, is a very rare extrapulmonary manifestation of tuberculosis, especially in children. Aim: This article presents a clinical case of a 21-month-old male patient with tuberculous osteoarthritis affecting the ankle joint. The rarity of this pathology underscores the critical importance of swift diagnosis and a multidisciplinary approach involving specialists from diverse medical fields. Results: Early initiation of specific antituberculous treatment, coupled with timely surgical intervention, ameliorated the patient’s immediate suffering. Furthermore, this combined therapeutic strategy holds promise for a favorable long-term prognosis regarding joint function. Conclusion: Tuberculosis in children exhibits markedly diminished incidence, and its extrapulmonary variants are exceedingly rare. However, clinicians should maintain a high index of suspicion, particularly when confronted with recalcitrant diseases that defy conventional therapeutic approaches. A comprehensive understanding of tuberculous osteoarthritis, despite its rarity, is pivotal for effective management. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2024 Case Report text/html info:doi:10.3897/bsms.4.121275 https://doi.org/10.3897/bsms.4.121275 https://bsms.arphahub.com/article/121275/ https://bsms.arphahub.com/article/121275/download/pdf/ en

10.3897/bsms.6.136135 2024-10-28 bsms

Metal-based organic complexes with anticancer activity Ivanova,Stefka Metal-based organic complexes antitumor drugs platinum complexes Bulgarian Society of Medical Sciences Journal 5: e136135 The discovery of the mechanism of action and the main structure-activity dependencies of platinum complexes create opportunities for rational synthesis of new metal-based organic complexes as potential antitumor drugs with reduced resistance and toxicity and / or a wider spectrum of antitumor activity. In the field of targeted synthesis of antitumor complexes has been working hard for 40 years. Initial research focused on obtaining complexes with a structure similar to cisplatin, and later on the search for new “non-classical” antitumor complexes. Selection of a suitable ligand system, ensuring effective accumulation in the antitumor tissue, replacement of platinum with other metals of the platinum groupg – ruthenium and palladium or metals with similar properties, such as gold, changing the degree of oxidation of the metal ion with for the purpose of kinetic and thermodynamic control over the binding of the metal complex to DNA bases. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2024 Research Article text/html info:doi:10.3897/bsms.6.136135 https://doi.org/10.3897/bsms.6.136135 https://bsms.arphahub.com/article/136135/ https://bsms.arphahub.com/article/136135/download/pdf/ en

10.3897/bsms.6.e136082 2024-12-11 bsms

The “suture-only” fixation in the treatment of proximal humerus fractures: A narrative review Rusimov,Lyubomir Proximal humeral fractures Transosseous sutures Surgical treatment Bulgarian Society of Medical Sciences Journal 6: e136082 Introduction: Surgical treatment of proximal humerus fractures (PHFs) is still associated with high complication and reoperation rates, most of them being implant related. In order to reduce such complications, a minimally-invasive technique was introduced by using only sutures for fixation of PHFs. Methods: For the arrangement of this narrative non-systematic review, an exploratory search in the MEDLINE (via PubMed) database using the keywords “proximal humeral fracture” and “sutures” was conducted. Results: The initial search in Pubmed yielded 254 studies, where only 8 were found to be possibly relevant. Following critical review, there were 6 studies that satisfied the inclusion criteria and were subject to further analysis. There were 325 patients with PHFs included in our study. The average age was 58 years (range 18–84 years). By fracture type there were 79 (24.3%) two-part greater tuberosity (GT) fractures with 36 (46%) of them associated with anterior dislocation, 9 (2.8%) two-part surgical neck (SN) fractures, 114 (35.1%) three-part fractures, and 124 (38.2%) four-part fractures, all of them being valgus impacted type. Conclusion: The “suture-only” technique obtains good clinical outcomes with lower complication and reoperation rates, but in selected types of unstable PHFs: two-part GT fractures with or without associated shoulder dislocation, and three- and four-part valgus-impacted fractures. While the indications for two-part SN fractures are contradictory, three- and four-part varus fractures, four-part fracture dislocations and split fractures are contraindicated for “suture-only” fixation. However, additional studies with a higher level of evidence are necessary to support the routine use of the “suture-only” technique in the treatment of these selected types of PHFs. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2024 Review Article text/html info:doi:10.3897/bsms.6.e136082 https://doi.org/10.3897/bsms.6.e136082 https://bsms.arphahub.com/article/136082/ https://bsms.arphahub.com/article/136082/download/pdf/ en

10.3897/bsms.6.128341 2024-12-30 bsms

Laparoscopic no-mesh repair of a large Morgagni-Larrey hernia Dzhendov,Todor Anzhelova,Yoana Barguti,Fares Kostov,Vasil Tchervenyakov,Alexandar Diaphragmatic hernia Hernia Laparoscopy Morgagni-Larrey No-mesh Bulgarian Society of Medical Sciences Journal 6: e128341 Morgagni-Larrey hernia is a rare condition, often presenting with nonspecific symptoms or remaining asymptomatic. Surgical intervention is the primary treatment modality, typically performed via trans-abdominal access, with an increasing trend towards employing minimally invasive techniques. Herein, we report a case detailing the successful laparoscopic repair of a large Morgagni-Larrey hernia without the use of mesh. The patient, a 55-year-old male, presented with chest pain following blunt thoraco-abdominal trauma. Chest radiographs and 3D-CT scan revealed a dense mass in the precordial space, initially suspected to be a diaphragmatic rupture. The diaphragmatic defect which was repaired laparoscopically, appeared to be a large Morgagni-Larrey hernia rather than a rupture. At the two-year follow-up, a repeat 3D-CT and laparoscopy were conducted to assess the previous repair and address a port site (drain site) hernia. No intra- or postoperative complications were encountered. Our experience supports the safety and efficacy of the laparoscopic no-mesh technique for repairing large Morgagni-Larrey hernias. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2024 Research Article text/html info:doi:10.3897/bsms.6.128341 https://doi.org/10.3897/bsms.6.128341 https://bsms.arphahub.com/article/128341/ https://bsms.arphahub.com/article/128341/download/pdf/ en

10.3897/bsms.7.143951 2025-02-10 bsms

Pharmacological treatment of predominantly storage low urinary tract symptoms (LUTS) in men – a review Mladenov,Boris LUTS voiding storage α1-blockers antimuscarinics combination Bulgarian Society of Medical Sciences Journal 7: e143951 Low urinary tract symptoms (LUTS) are common, very bothersome and with increased frequency in aging male population. Apart from voiding symptoms many men are struggling with moderate and severe storage symptoms, which influence dramatically their quality of life. One of the treatment options is pharmacotherapy, where several drug groups are available nowadays – among them α1-blockers and antimuscarinics. While every group has its advantages and side effects, the combination of those two have shown increased efficacy and acceptable safety when used in the good selected population of patients with combined voiding and storage LUTS. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Review Article text/html info:doi:10.3897/bsms.7.143951 https://doi.org/10.3897/bsms.7.143951 https://bsms.arphahub.com/article/143951/ https://bsms.arphahub.com/article/143951/download/pdf/ en

10.3897/bsms.7.144070 2025-04-10 bsms

Oxidative stress and neuroregenerative processes – pathophysiological correlations and new pharmacotherapeutic approaches in the treatment of neuroregenerative diseases Ivanova,Stefka Obreshkova,Danka Atanasov,Petar Mladenov,Boris Atanasova,Venceslava Ibrahim,Adel Oxidative stress neuroregenerative processes parkinsonism Alzheimer’s disease Bulgarian Society of Medical Sciences Journal 7: e144070 The aims of the current study are estimation of the correlations between oxidative stress and neuroregenerative processes and new pharmacotherapeutic approaches in the treatment of Parkinsonism. The investigation has been made through the existing electronical database of medical sources. Oxidative stress arises from an increased production of reactive oxygen/nitrogen species (ROS/RNS) or from a failure of the body’s antioxidant defenses, characterized by a reduced ability of endogenous systems to combat the oxidative attack directed at target biomolecules. It is broadly defined as a lack of balance between the levels of reactive oxygen/nitrogen species (ROS/RNS) and the body’s ability to counteract their effect through antioxidant defence systems. Free-radical induced attack has been associated with the onset of numerous health conditions such as neurodegenerative diseases (Parkinson’s, Alzheimer’s, Huntington’s and amyotrophic lateral sclerosis), cardiovascular and inflammatory diseases. In addition, the irreversible progression of oxidative deposition caused by reactive oxygen species (ROS) leads to accelerated biological aging, blocked biological functions, and overall. Other risk factors for neuroregenerative processes are glutamate toxicity, autoimmune, protein aggregation, inflammation. The most severe motor neuron degenerative illness is Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s disorder). info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Research Article text/html info:doi:10.3897/bsms.7.144070 https://doi.org/10.3897/bsms.7.144070 https://bsms.arphahub.com/article/144070/ https://bsms.arphahub.com/article/144070/download/pdf/ en

10.3897/bsms.7.144938 2025-05-19 bsms

Dual plate fixation of unstable proximal humerus fractures: A Narrative review Rusimov,Lyubomir Proximal humeral fractures Medical column insufficiency Dual plating Additional plate Double plate Bulgarian Society of Medical Sciences Journal 7: e144938 Introduction: Medial column instability has been identified as a key factor contributing to the increased failure rates observed after locking plate (LP) fixation for unstable proximal humerus fractures (PHFs). Recent studies have reported promising biomechanical and clinical outcomes with the use of LP fixation augmented by an additional plate for medial column stabilization. The current article provides an overview of the available clinical literature for dual plate fixation of unstable PHFs with medial column instability. Materials and methods: For the arrangement of this narrative, non-systematic review, an exploratory search in the MEDLINE (via PubMed) database using the keywords combinations: “proximal humerus fracture” and “dual plate”; “proximal humerus fracture” and “double plate”; “proximal humerus fracture” and “additional plate” was conducted. Results: The initial search in Pubmed yielded 24 studies, but only 9 studies satisfied the inclusion criteria and were subject to further analysis. There were 165 patients with PHFs in the nine included studies. The average age was 57 years (range 18–84 years). The average follow-up was 21.8 months (range 12–52 months). The average Constant-Murley Score at the final follow-up was 79.9 (71.5–90.4). There were a total of 12 (7.3%) reported clinically relevant complications and 15 (9.1%) re-interventions. Various plates were used as additional fixation to the PHLP: 1/3 tubular plate; a Variable Angle Locking Compression Plate (Distal Radius System); non-locking 3-hole T-plate; 2.7-mm T-shaped locking plate; anatomical medial locking plate; 2.7-mm micro-locking plate; Conclusion: Adding a second plate to PHLP fixation for unstable PHFs with medial column insufficiency has shown promising clinical outcomes with a relatively low complication rate, despite the additional soft tissue dissection required. The anterior placement of the secondary plate is less technically demanding and can serve as a temporary reposition tool. However, anterior plating has been associated with a higher risk of avascular necrosis compared to medial plating. The variability in techniques and implants used for dual plating complicates drawing definitive conclusions. Moreover, the current evidence is limited, and additional studies with a higher level of evidence are needed to support the efficacy and routine application of the dual plating technique for unstable PHFs. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Review Article text/html info:doi:10.3897/bsms.7.144938 https://doi.org/10.3897/bsms.7.144938 https://bsms.arphahub.com/article/144938/ https://bsms.arphahub.com/article/144938/download/pdf/ en

10.3897/bsms.7.153453 2025-05-23 bsms

Surgery – from the barber-surgeon era to modern times Vretenarova,Teodora Atanassov,Teodor Todorova,Katya History surgery barber-surgeon modern era Bulgarian Society of Medical Sciences Journal 7: e153453 Surgical practice dates back to ancient times, long before recorded history, and is characterized by its invasive methods for treating medical conditions. While early civilizations laid the foundation for understanding the human body, its functions, and anatomy, later generations refined these concepts, shaping modern medical theories. This article explores the historical role of barber-surgeons, their impact on the evolution of surgical practice, and the advancements that led to the establishment of surgery as a highly specialized medical discipline. Key milestones, such as the introduction of anesthesia, antiseptic techniques, and modern surgical education, will be examined, along with notable figures who transformed the field. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Review Article text/html info:doi:10.3897/bsms.7.153453 https://doi.org/10.3897/bsms.7.153453 https://bsms.arphahub.com/article/153453/ https://bsms.arphahub.com/article/153453/download/pdf/ en

10.3897/bsms.7.166399 2025-08-26 bsms

Round ligament varicosity – a rare mimicker of inguinal hernia in pregnancy Popivanov,Georgi Konaktchieva,Marina Marangozov,Svetlozar Tabakov,Mihail Ignatov,Atanas Delchev,Yancho Mutafchiyski,Ventsislav Round ligament varicosity pregnancy inguinal hernia Bulgarian Society of Medical Sciences Journal 7: e166399 Introduction: Round ligament varicosity (RLV) is a rare condition in pregnancy, with approximately 80% of the women being referred by gynaecologists with clinical suspicion of groin hernia. Herein, we report a case of right RLV with a brief review of the literature to raise attention to this condition that can easily be misdiagnosed as a groin hernia thus leading to unnecessary interventions. Case report: A 26-year-old woman presented with dull intermittent pain in the right groin and a lump in the right groin that appeared during the third trimester of the first pregnancy and disappeared after the delivery. The physical exam was normal, so RLV was suspected. During the second pregnancy, she complained of a slight swelling that appeared in the third trimester, accompanied by mild discomfort in the right groin. The physical exam revealed a small lump visible only in a standing position. The US demonstrated multiple dilated and tortuous veins in the inguinal canal that collapsed on pressure and became more prominent on the Valsalva manoeuvre. Doppler US confirmed the venous flow. The exam performed by a vascular surgeon showed multiple dilated pelvic veins and patent blood flow in the major veins of both limbs. Conclusion: The RLV can easily be misdiagnosed as a groin hernia. The exact and timely diagnosis of RLV is critical to avoid unnecessary surgery and diminish the anxiety of the pregnant woman. The differential diagnosis of RLV is relatively straightforward when the surgeon is aware of RLV and the specific US findings. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Case Report text/html info:doi:10.3897/bsms.7.166399 https://doi.org/10.3897/bsms.7.166399 https://bsms.arphahub.com/article/166399/ https://bsms.arphahub.com/article/166399/download/pdf/ en

10.3897/bsms.7.150495 2025-10-20 bsms

Persistent patent omphalomesenteric duct versus persistent patent urachus in infants Lilov,Stoyan Atanasova,Nia Dimitrov,Mihail Tolekova,Nadezhda Pamukova,Kaya Plachkova,Radostina Emilova,Mihaela Hristov,Hristo Donchev,Daniel Garvanska,Galya Shivachev,Hristo Omphalomesenteric duct vitelline duct patent urachus congenital anomalies pediatric surgery surgical management Bulgarian Society of Medical Sciences Journal 7: e150495 Introduction: Persistent patent omphalomesenteric duct (PPOMD) and persistent patent urachus (PPU) are rare congenital anomalies that present with a persistent connection between the umbilicus and the embryonic structures of either the intestinal or the urinary tract. The two conditions are most commonly diagnosed in infancy. Aim: We exhibit a comparative clinical case report of a 3-month-old male with PPOMD and a 2-month-old male with PPU with comparable clinical presentations. No concomitant congenital anomalies were registered. The cases aim to highlight the importance of accurate diagnosis in relation to the similar clinical presentation and the appropriate surgical management of these anomalies. Results: Both patients underwent physical examination, laboratory and imaging studies, which demonstrated similar results, with the fistulogram study in Case 1 confirming a PPOMD diagnosis. The two conditions were conclusively differentiated during the following surgical explorations. Conclusion: The two conditions (PPOMD and PPU) demonstrate similar clinical presentation and belong to a broader differential diagnostic spectrum, which requires prompt diagnosis and treatment in order to prevent complications. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Research Article text/html info:doi:10.3897/bsms.7.150495 https://doi.org/10.3897/bsms.7.150495 https://bsms.arphahub.com/article/150495/ https://bsms.arphahub.com/article/150495/download/pdf/ en

10.3897/bsms.7.168566 2025-10-31 bsms

Exercise performance in fontan patients – a single-center Bulgarian study Simeonov,Lyudmil Pechilkov,Dimitar Ivanova,Elena Kaneva-Nencheva,Anna Cardiopulmonary exercise testing exercise performance fontan procedure Bulgarian Society of Medical Sciences Journal 7: e168566 Aim: Exercise capacity in Fontan patients is reduced compared to healthy peers and progressive decline in cardiovascular function is expected over time. The purpose of this study is to present, analyze and discuss the initial Bulgarian experience with exercise performance of Fontan patients and to compare them to age-matched healthy peers. Additionally, we focused on understanding whether peak oxygen consumption can be predicted based on multiple independent variables. Materials and methods: The research is a retrospective observational study of 11 patients aged 8y-18y, who had undergone the Fontan procedure and underwent cardiopulmonary exercise testing in National Heart Hospital in Sofia, Bulgaria. Data were collected for a 1-year period. Simultaneously, 11 age-matched healthy patients were selected for comparison. Results: Patients with Fontan palliation had lower peak oxygen consumption (23.1 ml/kg/min vs. 30.1 ml/kg/min, P=0.046), percent-predicted peak oxygen consumption (52% vs. 76%, P<0. 001), percent-predicted peak work (56% vs. 82%, P<0.001), percent-predicted peak oxygen consumption at ventilatory anaerobic threshold (37% vs. 48%, P=0.04), resting saturation (93% vs. 97%, P<0.001) and saturation at peak work (84% vs. 95%, P<0.001). Male subjects and patients with left ventricular dominance exhibited a greater peak oxygen consumption. Conclusion: Exercise capacity in the Bulgarian Fontan cohort is reduced relative to healthy controls. Male gender and subjects with left ventricular dominance have a greater peak oxygen consumption. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Research Article text/html info:doi:10.3897/bsms.7.168566 https://doi.org/10.3897/bsms.7.168566 https://bsms.arphahub.com/article/168566/ https://bsms.arphahub.com/article/168566/download/pdf/ en

10.3897/bsms.7.172244 2025-10-31 bsms

Magnesium as an adjuvant in perioperative analgesia: data from randomised trials and meta-analyses Kosseva,Silvia Habilov,Sezen Milushev,Slav Kerim,Kerim Davidova,Gabriela Anesthesia analgesic request consumption MgSO4 multimodal opioids postoperative pain recovery requirements scores Bulgarian Society of Medical Sciences Journal 7: e172244 Introduction: The role of magnesium in perioperative analgesia has been investigated by an increasing number of authors in recent years. The implementation of ERAS (Enhanced Recovery After Surgery) protocols in clinical practice necessitates the search for new co-analgesics (adjuvants) to include in a multimodal analgesic regimen that would reduce or eliminate the use of opioids. Their side effects, combined with the current opioid epidemic, have catalysed efforts to find new models of balanced anaesthesia and analgesia. Methodology: This literature review includes and analyses 38 clinical studies examining the analgesic properties of magnesium sulphate (MgSO4) over the past three decades. It covers 32 randomised controlled trials (RCTs), 5 systematic reviews and meta-analyses of RCTs, and one retrospective cohort study. The search was conducted in databases (PubMed, DeepDyve) using the following keywords: anesthesia, analgesic request, consumption, MgSO4, multimodal, opioids, postoperative, pain, recovery, requirements, scores Results: Approximately 90% of the analysed studies demonstrate a positive effect of perioperative magnesium administration on intraoperative anaesthetic and postoperative analgesic requirements, pain scores, quality of recovery, haemodynamic profile, and other measures, without leading to adverse effects or complications at the dosing regimens used. Conclusion: Analysis of the data indicates that intravenous magnesium is a potential analgesic with a favourable safety and cost-effectiveness profile and can play an important role as an adjuvant in perioperative analgesia. However, additional large-scale studies with standardised protocols are needed to determine its optimal dosages, as well as the indications and contraindications for its use in clinical anaesthesia practice. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2025 Review Article text/html info:doi:10.3897/bsms.7.172244 https://doi.org/10.3897/bsms.7.172244 https://bsms.arphahub.com/article/172244/ https://bsms.arphahub.com/article/172244/download/pdf/ en

10.3897/bsms.8.175110 2026-01-09 bsms

Composite reverse shoulder arthroplasty for metastatic disease with 5-year follow-up. Malouchev,Orlin Tasev,Borislav RSA composite aloplasty allograft metastaic disease renal-cell carcinoma Bulgarian Society of Medical Sciences Journal 8: e175110 We present a 67-old patient with pathologic fracture of the proximal humerus 5 monts after nephrectomy for the treatment of renal cell carcinoma. The patient was treated by resection of the proximal humerus and composite reverse shoulder artroplasty with humeral allograft. Satisfactory range of motion and good functional result (Constant score 74, 8 points less than the contralateral shoulder, DASH score 10) were achieved. In the case-report we present the surgical technique, possible complications and postoperative rehabilitation protocol, as well as literature review, comparing the different options for the treatment of large metaststic and primary bone tumors of the proximal humerus. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2026 Case Report text/html info:doi:10.3897/bsms.8.175110 https://doi.org/10.3897/bsms.8.175110 https://bsms.arphahub.com/article/175110/ https://bsms.arphahub.com/article/175110/download/pdf/ en

10.3897/bsms.8.154296 2026-02-16 bsms

C-reactive protein and cardiac repolarization in cirrhosis Emilova,Niya Динева,Добринка Moneva-Sakelarieva,Maria Kobakova,Yozlem Chaneva,Mariya Ionchev,Ionko Slaveva,Diana Popova,Mihaela Todorov,Radoslav Kostov,Konstantin Sarakostova,Silvia White blood cell count C-reactive protein procalcitonin QTc QTcd cirrhosis coronary disease acute myocardial infarction Bulgarian Society of Medical Sciences Journal 8: e154296 Introduction: The systolic and diastolic function of the left ventricle and the activation of the autonomic nervous system are main determinants of ventricular repolarisation. Purpose: We conducted an analysis of the association of inflammatory markers with indices of ventricular repolarisation (heart rate, duration of repolarisation period - QTc, dispersion of repolarisation - QTcd) as well as with prognostic scores in patients with alcoholic cirrhosis. A group of patients with chronic coronary disease (CAD) and another group with acute myocardial infarction (AMI) were used for comparison. Results: Procalcitonin correlated positively as tendency with Child-Pugh score in the patient group with alcoholic cirrhosis on therapy. Only WBC showed a trend for association with non-homogenous repolarization in the group of male patients with cirrhosis on therapy. Higher white blood count (WBC) was marginally related to shorter minimal repolarisation periods and with dispersion of repolarisation in AMI. Higher CRP was related as tendency with shorter minimal repolarisation periods, longer maximal repolarisation periods and correlated significantly positively with higher dispersion of repolarisation in AMI. Higher levels of CRP also correlated with prolonged maximal repolarization in stable CAD. Conclusions: The count of white blood cells and procalcitonin are associated with risk of complications in alcoholic cirrhosis. In patients with cirrhosis and infection on therapy, WBC is specific marker of increased dispersion of repolarisation. In contrast to cirrhosis, CRP is associated with the risk of ventricular arrhythmias in stable coronary disease, while both CRP and WBC correlated with repolarisation indices in acute myocardial infarction. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2026 Research Article text/html info:doi:10.3897/bsms.8.154296 https://doi.org/10.3897/bsms.8.154296 https://bsms.arphahub.com/article/154296/ https://bsms.arphahub.com/article/154296/download/pdf/ en

10.3897/bsms.8.174054 2026-02-16 bsms

The role of surgery in the multimodal treatment of gastrointestinal stromal tumors Dimitrov,Pavel Kjossev,Kirien Popivanov,Georgi Ivanov,Veselin Tabakov,Mihail GIST multimodal therapy organ-preserving surgery surgery radical resection Bulgarian Society of Medical Sciences Journal 8: e174054 Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Radical resection remains the only curative treatment for primarily resectable disease, whereas the extent of surgery should be carefully tailored to tumor location and biology. Given the heterogeneity in tumor size, location, and biology, the tailored surgical approach based on the imaging and molecular assessments is essential. Aim: This narrative review aims to highlight the evolving role of surgery in the multimodal management of GIST, outlining key principles of operative strategy and integration with systemic therapy. Main findings: Complete R0 resection is the cornerstone of treatment, while lymphadenectomy is unnecessary. Organ-preserving limited resections are oncologically adequate in most cases, provided rupture is avoided. In challenging anatomical sites, neoadjuvant imatinib may improve resectability. For advanced disease, tyrosine kinase inhibitors have reshaped outcomes, and surgery retains a role in selected responders. Conclusion: Surgery continues to play a pivotal role in the treatment of GIST, but optimal outcomes rely on tailoring the extent of resection to tumor size, location, and biology, while integrating systemic therapy where appropriate. The future of GIST management lies in increasingly individualized multimodal strategies, combining precise surgical techniques with targeted molecular approaches. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2026 Review Article text/html info:doi:10.3897/bsms.8.174054 https://doi.org/10.3897/bsms.8.174054 https://bsms.arphahub.com/article/174054/ https://bsms.arphahub.com/article/174054/download/pdf/ en

10.3897/bsms.8.160719 2026-03-27 bsms

Managing anastomotic leaks with EndoVAC: Case report Anzhelova,Yoana Vrachanski,Desislav Tishkov,Ivan Atanassov,Teodor Tchervenyakov,Alexandar EndoVAC gastric cancer surgical complications anastomosis leak vacuum-assisted closure multidisciplinary approach Bulgarian Society of Medical Sciences Journal 8: e160719 Background: Successful EndoVAC Management of Oesophago-jejunal Anastomotic Leak After Gastrectomy and Oesophageal Resection for Carcinoma. This case report highlights the effectiveness and safety of EndoVAC treatment for postoperative oesophago-jejunal anastomotic leaks. Anastomosis leaks following oesophageal cancer surgery are serious complications that often result in prolonged hospital stays and increased mortality rates. Despite advancements in surgical techniques and perioperative care, managing these leaks remains a challenge. Traditional treatment methods, such as surgical reoperation and stent placement, may not always be appropriate. Endoscopic vacuum-assisted closure (EndoVAC) therapy has demonstrated promising results in this context. The advantages of vacuum therapy, as reported in the literature, include removing exudates, reducing bacterial invasion, and promoting tissue granulation. The presented case report discusses the mechanisms of action, clinical outcomes, and benefits of EndoVAC therapy, emphasising the importance of a multidisciplinary approach involving surgeons, radiologists, gastroenterologists, and intensive care specialists. Aims: Clinical case report and literature review. Materials and method: A 59-year-old male patient presented with gastric adenocarcinoma involving the cardia (Siewert Type 3). He underwent а gastrectomy with Y (Roux loop) oesophago-jejunal anastomosis. Oesophago-pleural fistula due to anastomotic insufficiency of the anastomosis occurred on 8th postoperative day. Video-assisted thoracoscopic surgery (VATS) was performed for the placement of para-oesophageal drains with local debridement and lavage of the pleural cavity and mediastinum on the 9th postoperative day. EndoVAC system was placed endoscopically. PEJ also was placed. After 12 days with four sponge changes a significant improvement was observed and the patient started oral feeding. He was discharged on 29 post-op day. Three months later а check endoscopy was performed that showed full closure of the defect. Results and discussion: This serious complication after surgery can be treated successfully with vacuum therapy with satisfying results. A multidisciplinary approach greatly enhances the chances for a successful outcome. info:eu-repo/semantics/altIdentifier/eissn/3033-1471 info:eu-repo/semantics/altIdentifier/pissn/2815-4959 info:eu-repo/semantics/openAccess CC BY 4.0 Bulgarian Society of Medical Science 2026 Case Report text/html info:doi:10.3897/bsms.8.160719 https://doi.org/10.3897/bsms.8.160719 https://bsms.arphahub.com/article/160719/ https://bsms.arphahub.com/article/160719/download/pdf/ en